iosr-JDMS   Volume-15 ~ Issue-2 ~ February-2016

Abstract: Vitiligo is an acquired autoimmune disorder characterized by loss of functional melanocytes from the epidermis affecting 0.3-1.1% worldwide with no sex predilection. Topical or systemic PUVA has been the mainstay of treatment until the introduction of NBUVB in 1997.NBUVB (311nm) has been reported to be an effective and safe therapeutic option in Vitiligo patients. We studied 56 patients attending Vitiligo clinic of GGH, VIJAYAWADA with various forms of Vitiligo and treated twice weekly with NBUVB therapy and followed up for repigmentation response. Out of 56 patients studied, majority being paediatric(32.14%) with no sex predilection(M-48.2%,F-51.7%),of them Vitiligovulgaris-66.7%, Acrofacial vitiligo-28.5%, other forms-5.3% . Dropouts were 32.14% during the course of treatment due to side-effects and poor compliance. Response for repigmentation is Excellent (>75%) in 21.05%,Good(50-75%) in 26.31%, Moderate (25-50%) in 36.84%, poor(<25%)in 15.78% of patients.

[1]. Lim HW, Hexsel CL. Vitiligo:To treat or not to treat. Arch Dermatol 2007;143:643-6.
[2]. Njoo MD, spuls PI, Bos JD, Westerhof W. Treatment of generalized vitiligo in children with NBUVB. J Am AcadDermatocol 2000;42:245-53.
[3]. Kanwar AJ, Dogra S. NBUVB for the treatment of generalized vitiligo in children. Clin Exp Dermatol 2003;139: 393
[4]. Anbar TS, Westerhof W, Rahman AT, KhayyatMA.Evaluation of the effects of NBUVB in both segmental and non-segmental vitiligo affecting different sites.PhotodermatolPhotoimmunolphotomed 2006;22:157.
[5]. ]Serish, Srinivas CR. Minimal erythema dose(Med) to NBUVB and BBUVB: A pilot study. IJDVL 200;2 ;68:63-4
[6]. Westerhof W, Nieuweboer-krobotova L. Treatment of vitiligo with NBUVB vs PUVA. Arch Dermatol 1997;133:1525-8
[7]. Scherschun L, Kim JJ, Lim HW. NBUVB is a well-tolerated treatment for vitiligo.J Am AcadDermatol 2001;44:999-1003

Abstract: Handlebar hernias are abdominal wall hernias resulting from direct trauma to the anterior abdominal wall. They usually result at weak anatomic locations of the abdominal wall. Such traumatic hernias are rare, requiring a high index of suspicion for a clinical diagnosis. We report the case of a handlebar hernia resulting from an injury sustained during a vehicular injury, and discuss the management of such injuries. Key Words: Handlebar, hernia

[1]. Dimyan W, Robb J, MacKay C. Handlebar hernia. J Trauma. 1980;20:812–3.
[2]. Goliath J, Mittal V, McDonough J. Traumatic handlebar hernia: A rare abdominal wall hernia. J Pediatr Surg. 2004;39:e20–2.
[3]. Cheng S, Ko W, Liu C. Handlebar hernia: A misleading term. Injury Extra. 2005;36:309–11.
[4]. Chen HY, Sheu MH, Tseng LM. Bicycle-handlebar hernia: A rare traumatic abdominal wall hernia. J Chin Med Assoc. 2005;68:283–5.
[5]. Prada Arias M, Dargallo Carbonell T, Estevez Martinez E, Bautista Casasnovas A, Varela Cives R. Handlebar hernia in children: Two cases and review of the literature. Eur J Pediatr Surg. 2004;14:133–6.
[6]. Mitchiner JC. Handlebar hernia: Diagnosis by abdominal computed tomography. Ann Emerg Med. 1990;19:812–3.

Abstract: Inguinal hernia is a commonly encountered problem by surgeon and various methods have been advocated for repair by various authors but each has got its own merit.Lich tenstein tension free mesh repair has been considered as standard procedure for inguinal hernia repair with low recurrence. With advancement of minimally invasive surgery laparoscopic hernia repair is gaining popularity. The aim of the study is to compare the results of Lichtenstein repair with laparoscopic TAPP(Trans abdominal pre peritoneal repair) in inguinal hernia. Laparoscopic TAPP repair is associated with faster recovery, less pain,better cosmesis and , least post operative complications.

Key Words: Inguinal Hernia,Laproscopic TAPP Repair,Lichtenstein Repair

[1]. Gordon,T.L(1945);Bassini's operation for inguinal hernia;BMJ;2(4414);181-182
[2]. Lichtenstein.L,Shulman.AG(1986);ambulating outpatients hernia surgery including a new concept, introducing tension free repair; International surgery;71(1);1-4
[3]. Fitgibbons R J;Laparoscopic hernioplasty;SAGES 1992;Postgraduate course Washington manual; April 1992
[4]. Kurzer M,Kark A,Hussain S T; Day case inguinal hernia repair in elderly:a surgical priority; Hernia;2009;13;131-136 (PMID 19034602)
[5]. Cavazzola LT,Rosen M J;Laparoscopic versus open inguinal hernia repair;Surg Clin.North Am;2013;93;1269-1279 (PMID 24035088)
[6]. NICE guideline :Laparoscopic surgery for inguinal hernia repair. Technology appraisal guideline no.83;www.nice.org.uk 2007
[7]. Mc Cormak K,Wake B,Perez J,Fraser C,Cook J,Mcintosh E,Vale L, Grant A; Laparoscopic surgery for inguinal hernia repair: systemic review of effectiveness and economic evaluation.Health Technol Assess;2005;9;1-203.iii-iv( Pub med)

Abstract: Laparoscopic pyeloplasty is a first-line option for the management of ureteropelvic junction obstruction. We evaluated various presentations and therapeutic modalities for ureteropelvicjunction obstruction and their outcomes in our department.. All patients who underwent pyeloplasty recovered uneventfully except three who developed prolonged extravasation of urine. One patient developed wound infection. Average hospital stay was 12 days. Follow up studies showed good renal function on the side of pyeloplasty in 21cases.Hence, Laparoscopic pyeloplasty is feasible in normal and difficult ureteropelvic junction abnormalities. Keywords: Laparoscopic pyeloplasty, ureteropelvic junction obstruction.

[1]. Sikandar Ali Mughal and SirajuddinSoomro, Journal of Surgery Pakistan (Interatinal) 13 (4) October – Decmber 2008, Pages 163 – 166.
[2]. Pratipal Singh, Paresh Jain, AnandDharaskar, Anil Mandhani, et al, Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, Indian Journal of Urology, January-March 2009, Pages 68 – 71.
[3]. Stephanie J. Symons, Victor Palit, Chandra ShekharBiyani, Jon J. Cartledge, Anthony J. Browning and Adrian D. Joyce, Indian Journal of Urolgy, January-March 2009, Pages 27 – 33.
[4]. G. A. Maranya and P. R Odour, East and Central African Journal of Surgery, Volume 9, Number 2 – December 2004.
[5]. Gordon F Schwartz, Ronald I Cantor and William A Biermann, Archives of Surgery-Vol 122, Dec 1987, Pages 1430-1434.

Abstract: Radiotherapy is often the primary treatment modality for unresectable squamous cell head and neck cancer ,but the optimal fractionation regimen has been controversial. The objective of this study was to evaluate and compare the efficacy and toxicity of accelerated fractionation with concomitant boost ( group A) against standard fractionation regimen ( group B). Patients were randomly assigned to receive radiotherapy delivered with accelerated fractionation with concomitant boost after 3 weeks of standard 30Gy/15fractions/3week, as 1.4 Gy/fraction twice daily with a 6-h interfraction interval ,5days/week for 3 weeks to 72 Gy/ 6 weeks and compared to standard fractionation at 2Gy/fraction/day,5days/week, to 70Gy/35fractions/7weeks .All patients in both treatment groups received concomitant chemotherapy in the form of weekly injection of cisplatin (30mg/m2).Of the 100 patients entered ,only 90 patients were evaluable for outcome. The primary end point was locoregional control.

[1]. Jemal A, Bray F, Center MM et al,Global cancer statistics,CA Cancer J Clin 2011; 61(2):69-90.
[2]. Cummings B, keane T, pintilie M et al. Five year results of a randomized trial comparing hyperfractionated to conventional radiotherapy over four weeks in locally advanced head and neck cancer, radiother oncol,2007;85:7-16.
[3]. Wither, H.R., L.J. Peters and J.M.G. Taylor.1995. Dose response relationship for radiation therapy of subclinical disease, Int. J. Radiat Oncol. Biol. Phys., 31: 353-359.
[4]. Peters, L.J., H. Goepfert, K.K. Ang, et al. Evaluation of the dose of post operative radiation therapy of Head and Neck cancer, First report of prospective concomitant boost with concurrent radiotherapy randomized trial, Int. J. Radiat Oncol Biol. Phys., 26: 3-11.

Abstract: Pre-eclampsia is a potentially fatal disorder and a major cause of morbidity and mortality in developing nations and anaesthetic management in these patients is challenging . Maternal outcomes of severe preeclampsia posted for caesarean under general anaesthesia and spinal anaesthesia were studied and analysed.Sixty parturients with severe pre-eclampsia posted for caesarean section under spinal or general anaesthesia were randomised into two groups of 30 each. Demographic data including age, weight , gravida , gestational age were recorded . Blood pressure and Heart rate was monitored in the ward before induction, after intubation and at 5 min intervals till completion of the operation and after spinal anaesthesia at 5 min intervals. The incidence of maternal morbidity , mortality and admissions in ICU were analysed . Spinal anesthesia for caesarean delivery has better maternal outcome in terms of hemodynamic stability and postoperative recovery when compared to general anesthesia. Spinal anesthesia is a safe alternative to general anaesthesia in severe preeclampsia patients.

Key words: Caesarean , General anaesthesia , Severe Preeclampsia, Spinal anaesthesia.

[1]. Department of Health. Why mothers die. Report on Confidential Enquiries into Maternal Deaths in the UK 1994-96. TSO, 1998. Saftlas A. F., Olson D. R., Franks A. L., Atrash H. K., Pokras R. (1990). Epidemiology of preeclampsia and eclampsia in the United States, 1979–1986. Am. J. Obstet. Gynecol. 163, 460–465 [PubMed]
[2]. Gogarten W. Preeclampsia and anaesthesia. Curr Opin Anaesthesiology 2009;22:347–51Diagnosis and management of preeclampsia and eclampsia.ACOG Practice Bulletin No. 33. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002;99:159–67 Lindheimer MD, Taler SJ, Cunningham FG. Hypertension in pregnancy. J Am Soc Hypertens 2008;2:484–94. Gambling DR. Hypertensive disorders. In: Chestnut DH, editor. Obstetric Anesthesia. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2004Dyer RA, Piercy JL, Reed AR. The role of the anaesthetist in the management of the pre-eclamptic patient. Curr Opin Anaesthesiol 2007;20:168-74.

Abstract: Carcinoma of the stomach was the leading cause of cancer-related death worldwide through most of the 20th century. In many parts of the world, however, the incidence of gastric cancer has gradually decreased, principally because of changes in diet, food preparation, and other environmental factors. In India it is fourth common malignancy and second common cause of death due to malignancy. The detection of early gastric cancer in India is still less than 10%.1 Objectives: The present study is to discuss about the incidence, risk factors, clinical features, and management of carcinoma of stomach.

[1]. Parkin DM. Studies of cancer in migrant populations: methods and interpretation. Rev Epidemiol Sante Publique 1992;40:410.
[2]. Juan Rosai, Carcinoma Stomach, Chapter 21, Surgical Pathology, Rosai and Ackerman, 9th edn, Mosby, 2004, p 633-35.
[3]. Isaacson PG. Gastric MALT lymphoma: from concept to cure. Ann Oncol 1999;10:637.
[4]. Flora ED, Wilson TG, Martin IJ, et al: A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery:Experimental models, techniques, and applicability to the clinical setting. Ann Surg 247:583, 2008.
[5]. Smith RA, Cokkinides V, Eyre HJ: American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer J Clin 2006; 56:11-25.quiz, 49-50.
[6]. Dempsey T.Daniel,Stomach Chapter 26 in Schwartz's principles of surgery Brunicardi F.Charles, Anderson K.Dana ,Billiar R.Timothy ,Dunn L.David, HunterG.John,MatthewsB.Jeffrey,PollockE.Raphael 9thedition,2009;p1733-1739

Abstract: The greatest concern expressed is that the medical curriculum is not in tune with the health needs of the society. There is overemphasis on the acquisition of knowledge as against development of skills and attitudes, lack of integrated approach to teaching-learning, outmoded assessment system that lacks validity, reliability and transparency. The objective of the study isto evaluate the effectiveness of the Case-Based Integrated Teaching (C-BIT) Model.This was a prospective study, carried out for undergraduate medical students at a Deemed University from Feb 2011 to July 2013. Ten C-BIT sessions were conducted for the students posted for clinical teaching in Department of Surgery.

[1]. Supe AN, Burdick WP. Challenges and Issues in Medical Education in India. Academic Medicine 2006; 81(12):1076-80.
[2]. Sood R, Adkoli BV. Medical Education in India – Problems and Prospects. J IndAcadClin Med 2000; 1(3):210-12.
[3]. Haranath PSRK. Integrated Teaching in Medicine – Indian scene. Indian Journal of Pharmacology 2013;45(1):1-3.
[4]. Government of India, National Health Policy 2002; Ministry of Health and Family Welfare, Government of India, New Delhi.
[5]. Powar KB. Medical Education Ch. 6 In: Expanding Domains in Indian High Education, Association of Indian Universities, New Delhi 2012:115-20.
[6]. Ananthkrishnan N. Medical Education in India: Is it still possible to reverse the downward trend? The National Medical Journal Of India 2010; 23(3):156-60.
[7]. Muller JH , Jain S, Loeser H , Teby DM. Lesson learned about integrating a medical school curriculum: perceptions of students, faculty and curriculum leaders. Med Edu 2008; 42:778-85.
[8]. Wing Pong Chan, Chung Yi Hsu, Chuang Ye Hong. Innovative "Case- Based Integrated Teaching "in an Undergraduate Medical Curriculum : Development and Teachers‟ and Students‟ Responses. Ann Acad Med Singapore 2008; 37:952-956.

Abstract: The therapeutic approach in children with Nasolacrimal duct obstruction (NLDO)differs from that used in adults. While Dacryocystorhinostomy(DCR) is the most common procedure in adults. It is carried out less frequently in children. It is indicated for children with persistent NLDO refractory to probing and in cases of recurrent or chronic dacryocystitis. Aims and objectives : The objective of the study is to report a series of 24 cases of paediatricepiphora who underwent Endoscopic Endonasal Dacryocystorhinostomy surgery (E.E.DCR), for primary obstruction of Nasolacrimal Duct (NLD) and results evaluated.

[1]. Gupta AK, Bansal S. Primary endoscopic dacryocystorhinostomy in children -- analysis of 18 patients. Int J Pediatr Otorhinolaryngol. 2006;70(7):1213-1217. doi:10.1016/j.ijporl.2005.12.016.
[2]. Eloy P, Leruth E, Cailliau A, Collet S, Bertrand B, Rombaux P. Pediatric endonasal endoscopic dacryocystorhinostomy. Int J Pediatr Otorhinolaryngol. 2009;73(6):867-871. doi:10.1016/j.ijporl.2009.03.006.
[3]. Komínek P, Cervenka S. Pediatric endonasal dacryocystorhinostomy: a report of 34 cases. Laryngoscope. 2005;115(10):1800-1803. doi:10.1097/01.mlg.0000175678.73264.88.
[4]. Berlucchi M, Staurenghi G, Rossi Brunori P, Tomenzoli D, Nicolai P. Transnasal endoscopic dacryocystorhinostomy for the treatment of lacrimal pathway stenoses in pediatric patients. Int J Pediatr Otorhinolaryngol. 2003;67(10):1069-1074. http://www.ncbi.nlm.nih.gov/pubmed/14550960. Accessed January 21, 2016.
[5]. Nowinski TS, Flanagan JC, Mauriello J. Pediatric dacryocystorhinostomy. Arch Ophthalmol (Chicago, Ill 1960). 1985;103(8):1226-1228. http://www.ncbi.nlm.nih.gov/pubmed/4026653. Accessed January 16, 2016.

Abstract: Subjects fulfilling inclusion and exclusion criteria were evaluated for hypersensitivity and randomly divided into four groups: group A receiving 2% sodium fluoride, group B receiving 10% strontium chloride, group C receiving 0.125% methyl prednisolone and group D distilled water. All the reagents were applied through iontophoresis. The result was evaluated immediately, one week, three weeks and six weeks after the application of the reagent. SEM study was done on dentine specimens after application of above mentioned reagents through iontophoresis. After statistical analysis, it was found that comparison between groups A and B was statistically non-significant, groups A and C, groups A and D, groups B and C, groups B and D and groups C and D were significant. In SEM analysis maximum occlusion of tubules was seen in sodium fluoride group. It was concluded that single application of the above mentioned desensitizing reagents through iontophoresis proved to be better therapeutic reagents in comparison with distilled water.

Key words: Dentine hypersensitivity, iontophoresis, methyl prednisolone, sodium fluoride and strontium chloride.

[1]. Kumar NG and Mehta DS. Short-Term Assessment of the Nd: YAG Laser With and Without Sodium Fluoride Varnish in the Treatment of Dentin Hypersensitivity - A Clinical and Scanning Electron Microscopy Study. J Periodontol 2005; 76:1140-1147.
[2]. Madhavan S, Nayak M, Shenoy A, Shetty R, and Krishna Prasad. Dentinal hypersensitivity: A comparative clinical evaluation of CPP-ACP F, sodium fluoride, propolis, and placebo. J Conserv Dent. 2012 Oct; 15(4):315-8.
[3]. Bartold PM. Dentinal hypersensitivity: a review. Aust Dent J.2006; 51: (3): 212-18.
[4]. Rosing CK, Fiorini T, Liberman D N and Cavagni J. Dentine hypersensitivity: analysis of self-care products. Braz Oral Res. 2009;23 Suppl 1:56-63
[5]. Absi EG, Addy M and Adams D. Dentine hypersensitivity. A study of patency of dentinal tubules in sensitive and non sensitive cervical dentine. J Clin Periodontol 1987; 14:280-84.

Abstract:Although measures of consumer satisfaction are increasingly used to supplement administrative measures in assessing quality of health care, little is known about measuring patient's satisfaction in Medical Center area, with health care services, in addition to identifying the determinants of satisfaction to detect and report patients' perceived strengths and weaknesses of the health care service provided. This study intends to measure patient's satisfaction at both the physician and the hospital level. In the current study, a satisfaction questionnaire was distributed to outpatient's clinic at Imam Muhammad Ibn Saud Islamic University Medical Center area. Descriptive analysis was used to measure patient's satisfaction with physicians and hospital services.

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1997; 42(2):165-77.
[4]. Alzolibani, A. (2011) "Patient satisfaction and expectations of the quality of service of University affiliated dermatology clinics."
Journal of Public Health and Epidemiology Vol. 3(2), pp. 61-67.
[5]. Britton, JR (2012) "The Assessement of Satisfaction with care in the perinatal period." Journal of Psychosom Obstet Gynaecol.
USA: Denever. Jun, 33(2):37-44.
[6]. Eiad A.AL Faris , Etall (1996) patient satisfaction with accessibility and services offered in Riyadh health centers. Saudi medical
journal 1996:17(1): 11-17.

Abstract: Objective: This survey aimed to investigate the attitude of senior dental students towards rubber dam use, especially in endodontic practice. Methods: A questionnaire-based survey was conducted on the final year dental students. A self-administered questionnaire was designed and consisted of relevant questions to ascertain attitudes, opinions and practices concerning rubber dam use.

[1]. Elderton RJ. A modern approach to use of rubber dam. Dental Practitioner and Dental Record. 1971; 21: 187–193, 226–232, 267–273.
[2]. European Society of Endodontology, "Quality guidelines for endodontic treatment: consensus report of the European society of endodontology," International Endodontic Journal. 2006; vol. 39, no. 12, pp. 921–930.
[3]. Karaouzas L, Kim YE, Boynton JR, Jr. Rubber dam isolation in pediatric patients: a review. J Mich Dent Assoc 2012; 94(1): 34-7.
[4]. Bruce WS, Sharon C. Practical tips for the dental assistant to simplify the process for dry field isolation. AEGIS Communications 2011; 7(3): 22-6.
[5]. American Academy of Pediatric Dentistry. Guidelines on pulp therapy for primary and young permanent teeth. Pediatric Dentistry 2009; 30, 170–174.
[6]. American Association of Endodontists Guide to Clinical Endodontics, 2004, 4th edn. Chicago, IL: American Association of Endodontists.

Abstract: This study was conducted on the Yemeni dental practitioners to gather data on the current opinions of the dental practitioners regarding some technical aspects of routine endodontic practice. Dental practitioners were asked to choose only answer that best fitted their clinical performance. The Chi-square test was used to compare proportions among groups and the significance threshold was set at p < 0.05. Of the respondents, only 7.1% used rubber dam isolations during endodontic treatments compared to other isolation method. A majority of respondents (37.1%) used radiographic method while whose used both electronic and radiographic method were 21.4%. Sodium hypochlorite was the most popular choice as a root canal irrigant (60.9%), while 12.9% used chlorhexidine..

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[6] Slaus G, Bottenberg P. A survey of endodontic practice amongst Flemish dentists. International Endodontic Journal. 2002; 35: 759-67.